Adaptive Text Messaging Intervention for Risky Drinking in Postpartum Women

摘要 提议的R34将开发一种理论驱动的自适应短信干预(TMI)，用于危险饮酒 产后妇女。危险饮酒在育龄女性中很普遍，超过一半的 怀孕期间减少饮酒的女性会提前三个月恢复到怀孕前的水平 产后。产后危险饮酒会削弱母亲照顾婴儿的能力，并与 虐待和忽视儿童的风险增加，参与儿童福利制度的风险增加，以及贫穷的长期儿童 足月孩子的结局。大多数从事危险饮酒的成年人不会寻求治疗，产后妇女 由于耻辱和对儿童保护服务的恐惧，可能特别不可能寻求正式治疗 参与其中。对于不寻求治疗的危险饮酒者来说，短信是一种很有前途的策略 可能特别适合产后妇女，因为它方便和匿名。这种方法还 具有广泛的扩展潜力，因为它能够以相对较低的成本接触到大量的人。这个 拟议的研究将应用多阶段优化策略(MOST)框架，这是一种受工程启发的框架 开发高效和可扩展的移动卫生干预措施的方法，以开发第一个自适应TMI 专为产后妇女高风险饮酒而设计。这项拟议的研究将完善一项理论 模型来通知TMI，该TMI基于复发预防模型并指定 压力、负性情绪、母亲自我效能感与饮酒意向及日常饮酒行为 产后妇女，以及她们对产后独特诱因的每日波动 (睡眠质量和婴儿易怒)。拟议的TMI将包括基于以下方面的行为改变干预 针对应对技能和避免动机的激励性访谈和认知行为疗法 饮酒，并根据压力、负面情绪和自我效能的波动进行适应性调整。特定的 目标是(1)通过生态瞬时评估对所提出的理论模型进行检验和提炼，共30个 为期14天，以确定每日压力波动、负面情绪和自我效能对应对的影响 触发因素及其对饮酒意图的影响；(2)通过以下方式制定TMI的内容和决策规则 通过与30名产后妇女的焦点小组收集的用户反馈的迭代周期；以及(3)进行试点 对50名女性进行微随机试验(MRT)，评估设计和方法的可行性，并获得 初步概念验证数据，为未来的全功率优化试验做准备。研究产品将是 一组用于产后危险饮酒的初步TMI成分，准备在一项 未来更大规模的R01，以及一套试行的EMA和MRT方法用于产后高危人群 酒鬼。

Abstract The proposed R34 will develop a theory-driven, adaptive text messaging intervention (TMI) for risky drinking in postpartum women. Risky drinking is prevalent among women of reproductive age, and more than half of women who reduce their alcohol use during pregnancy return to pre-pregnancy levels by three months postpartum. Postpartum risky drinking can impair a mother’s ability to care for her baby, and is associated with increased risk for child abuse and neglect and involvement with the child welfare system, as well as poor long- term child outcomes. Most adults who engage in risky drinking do not seek treatment, and postpartum women may be especially unlikely to seek formal treatment due to stigma and fears of child protective services involvement. Text messaging is a promising strategy for reaching non-treatment-seeking risky drinkers that may be particularly suitable for postpartum women, as it is convenient and anonymous. This approach also has wide scalability potential, as it is capable of reaching large numbers of people at relatively low cost. The proposed study will apply the Multiphase Optimization Strategy (MOST) framework, an engineering-inspired approach for developing efficient and scalable mobile health interventions, to develop the first adaptive TMI specifically designed for risky drinking in postpartum women. The proposed study will refine a theoretical model to inform the TMI that is based on the Relapse Prevention model and specifies the temporal relations of stress, negative mood, and maternal self-efficacy with intention to drink and daily drinking behavior in postpartum women, and their daily fluctuations in response to triggers that are unique to the postpartum period (sleep quality and baby irritability). The proposed TMI will include behavior change interventions based on motivational interviewing and cognitive behavioral therapy that target coping skills and motivation to avoid drinking, and that are adaptively tailored to fluctuations in stress, negative mood, and self-efficacy. Specific aims are to (1) test and refine the proposed theoretical model via Ecological Momentary Assessment with 30 women for 14 days to determine daily fluctuations in stress, negative mood, and self-efficacy in response to triggers and their impact on drinking intentions; (2) develop the content and decision rules for the TMI via iterative cycles of user feedback collected via focus groups with 30 postpartum women; and (3) conduct a pilot micro-randomized trial (MRT) with 50 women to assess feasibility of design and methods and obtain preliminary proof-of-concept data to prepare for a future fully-powered optimization trial. Study products will be a set of preliminary TMI components for postpartum risky drinking, ready for optimization and evaluation in a future larger scale R01, and a set of piloted EMA and MRT methods for the population of postpartum risky drinkers.